The Power to Improve NICU Feeding Practice: One Nurse’s Reflection

by Sue Ludwig and Kara Ann Waitzman

We’ll never forget what this nurse said.

After spending a whole day teaching NICU staff about neonatal feeding, we were led into the unit to consult with staff members.

One of the nurses who attended our seminar, we’ll call her Jackie, motioned us to come to the bedside of her current patient. Jackie had a huge grin on her face as she began to notice the infant slowly coming to an alert state and begin rooting. He eagerly took his pacifier when offered. When she began feeding him a few minutes later she shook her head, almost laughing.

We asked her what she was thinking, why the big grin?

She said, “I can’t believe I’m admitting this. I mean, I’ve been a NICU nurse for over 15 years, but I have never paid this much attention to a baby during feeding. We’re always so busy that when I sat down to feed a baby, I was just happy to be sitting down! I’d use that time to think about what I had to do next, what meds were due etc.”

She observed the infant as he ate and continued, “I mean, I watched the baby eat, of course, and stopped him if he looked like he was in trouble, but I wasn’t aware of the more subtle signs of stress. I never knew just how attentive I had to be to keep him safe and help him enjoy this. And to think how often we tried to make the babies eat even when they clearly didn’t want to! Arrrghh! I’m actually just pleasantly surprised that I have a whole new perspective. I’m relieved.”

She went on to explain that like most NICUs, they’d never had any specific orientation or education related to oral feeding. She fed babies like her preceptor taught her to feed babies 15 years ago. Period.

Jackie isn’t alone here.

It’s only through highly specialized education and awareness that you, as a NICU professional, can fully appreciate the short and long-term risks of sustaining outdated practice, an unsupportive culture and inconsistent communication AND realize the power you have to improve it!

When you begin to consistently address these issues, your unit’s practice and culture will improve and the old behaviors will fall away. Just like Jackie, you’ll see infants and your caregiving role through a new lens.

This clarity changes your practice. You won’t ever go back.